How can you talk about STIs or STDs with potential partners without being ashamed?
So, one of my biggest inspirations in talking about this kind of stuff is Ella Dawson. Ella Dawson did a TED Talk about how herpes changed her life.
She caught herpes in college from a person who was abusive to her and has had to deal with what that means ever since.
And instead of treating that as something to create shame and fault in on herself, she instead treated it as an opportunity to just educate a ton of people about how weirdly prejudice we are about STDs in a way that far outpaces their actual impact on someone’s life.
In this day and age, the most dangerous STI out there is COVID.
It’s not actually an STI but it’s really easy to catch if you are having sex with somebody.
The most common STI is the common cold, which isn’t technically an STI because it’s not transmitter only sexually or through sexual fluids and in sexual organs.
But if we are having sex with folks, it’s much easier to catch a cold that if we are just actually engaging with people.
The delineation that we make between STIs, sexually transmitted infections or diseases and other issues is a really weird one to make, depending upon what we are talking about.
So for instance, HPV.
HPV can happen literally anywhere on your body.
HPV is one of the leading causes of throat and mouth cancers.
Michael Douglas’ Catherine Zeta Jones’ husband famously talked about how he had throat cancer and it was almost certainly because he loves eating pussy.
And like a hero for out times, right?
HPV can be on your skin, anywhere on your skin.
It can be on your hands, your arms, anywhere.
HPV is highly, highly common and there are dozens of different strains of HPV that exist.
You can get vaccinated against the ones that are most likely to cause cancers but almost everybody has some kind of HPV somewhere on their body most of the time.
You can translate HPV a whole lot of ways but we consider it an STI because the strains of HPV that we tended to notice the most and care the most about were the ones that led to cervical cancer.
So even though they are also highly associated with throat and mouth cancers, also highly associated with penile cancers and other ones as well, because they were associated with cervical cancers, we decided it was a sexual transmission because the only way for it to pass between people there is for stuff to happen with a cervix, whether something is going towards a cervix and then dropping off some HPV or going from a cervix and carrying HPV with it.
But HPV again can live anywhere on your body. So it’s an STI but it can be transmitted in a lot of ways.
Herpes, the herpes simplex virus, the most common variant of it is called sores, HSV1. HSV1, over half the population has it.
If we talk about both HSVs together, more than two thirds of the population has at least one of them.
Lots of folks don’t know they have it.
A lot of people, it is asymptomatic.
Some people, their body just clears it on their own.
But most folks have HSV.
Cold sores don’t tend to be as stigmatized as genital sores even though it is the same virus.
There are two strains that we test for that can show up generally orally and/or genitally, which are HSV1 and HSV2.
And HSV1 does tend to show up more around the mouth.
And HSV2 does then does tend to show up more genitally but they can both show up either place.
There’s no huge distinction between them.
Chickenpox is also a herpes virus.
It’s also in the same family.
Chickenpox we don’t think of as an STI.
So again, when we think about STIs versus other illnesses or viruses as infections, the line that we draw tends to be more about which ones we stigmatize and shamed people for than about any actual difference in terms of how that virus or illness functions or impacts on your life.
Herpes for the vast majority of people who have it, they either have zero outbreaks or one outbreak utmost in their life.
Some people do have recurrent outbreaks.
There is medication to help with that.
But for most people, herpes doesn’t actually change their life much at all.
It doesn’t cause them much pain.
It doesn’t – it’s not going to kill them.
If you are pregnant and planning to give a vaginal birth and you have genital herpes, there can be issues during the vaginal birth.
You would want to talk to your doctor or midwife about that.
But for the most part, herpes doesn’t have a huge long-term impact on the lives of the vast majority of people who have it.
But it’s highly, highly stigmatized.
Whereas right now, COVID is currently killing 3,000-ish people a week in our country but we have decided that it’s over and we are going to do nothing to mitigate it other than vaccines if you feel like it.
So herpes kills nobody.
COVID kills tons.
But the one we shame is herpes.
So when it comes to this question like, “How do you talk to people about STIs or STDs without shame?”
I think the first step is working at unpacking internally your own shame and feelings about STIs and about potentially having an STI or potentially having transmitted the STI.
If you would not feel huge amounts of shame because the daycare crud you got from your nephew made you have a sinus infection.
Why are you feeling more shame because you caught the genital equivalent of a daycare crud?
It’s not that different.
It’s the same thing.
It’s not going to change your life in huge way.
So that’s what where the STIs these days are highly treatable, very easy to be contained.
They do not affect your life in serious ways at all.
Even HIV at this point with the medications that we have available, it is very easy for people to get to a place where the level of HIV in their bodies is undetectable, which means that it is untransmittable.
They cannot transmit it to others.
And if you are very worried about getting HIV, you can go on PrEP, pre-exposure prophylaxis.
I have a pill I take every day.
That means that I have a very high probability of being unable to get HIV.
Nothing is ever a hundred percent but I’m probably not going to get HIV.
There was a time where if you got HIV, your life expectancy was significantly changed.
No longer the case.
These days, people with HIV tend to live just as long as folks without it.
It doesn’t hugely change your life.
Syphilis, treatable with antibiotic, same with gonorrhea and Chlamydia.
As long as you are getting tested on a regular basis, you can address anything that happens in terms of STIs fairly quickly.
You can deal with it.
You can have it.
Be it something that happened in your life or something that changes the course of your life forever.
Shame is something that is put upon us and it is something that we carry and put upon ourselves and others.
So if you are worried about having a conversation about STIs with somebody, there is probably a component of shame within you that you still need to unpack.
There may also be a component of totally understandable fear of somebody else’s reaction if you reveal to them that you have an STI.
Some people do not react well when you tell them that you have an STI.
And those aren’t people to play with, especially if you are someone who likes to play with a lot of folks.
The majority of folks who do a lot of playing with other people, they get tested really regularly, they understand that there are risk of STI transmission and they understand that the vast majority of them are just like a cold or a sinus infection.
You get it treated.
You deal with it.
You move forward with your life.
So I think again, step 1, unpack your own shame about it.
Step 2, talk about it like a normal thing you would talk about.
Talk about it like you would talk about what pizza somebody is in to.
Talk about it like you would talk about the COVID precautions that somebody takes.
When I talk about STIs with folks, the conversation I have with them is the not this huge gut-wrenching conversation.
I say like, “Hey, I get tested for STIs every three months.
I get oral, vaginal, and anal swabs.
I get tested for gonorrhea and Chlamydia, syphilis, HIV.
And then yearly, I get tested for hep C.
I don’t currently get tested for HIV or for HSV because the testing at the VA, they would not give you unless you have a suspected transmission or a current outbreak.
But I do know that I have a history of HSV1 with oral cold sores.
So if you absolutely cannot take a risk on catching HSV, we should not kiss or play or make out or anything.”
In terms of like what I do for barrier protection, I tend to use barriers for sex with all the people I have sex with at this point for any penetrative sex, hand play, it depends upon the person and the setting.
At parties, I always use gloves for hand play because it’s easier for cleanup and keeping things separate.
For oral sex, barriers are dependent upon the comfort level of myself and others.
And then again, for penetrative sex either of my vagina or my anus or for me going into somebody else body, I use a condom.
I have a latex-sensitivity so I bring non-latex condoms with me everywhere and I have both regular size and large size so that whatever toy we are playing with or penis I’m playing with, I have options available.
What are your protocols?
How do you handle testing and STI prevention?
It’s a very easy conversation for me to have because I don’t feel any shame about the fact that I fuck a lot of people, that I have HSV1.
That’s just part of my life.
And so, I’m able to talk about it without it being an issue.
I’ve had and STI prevention conversation with an Iranian man who was in Kuala Lumpur and English was not his first language and we were able to make it through and entire negotiation of safer sex practices because I was able to ask some specific questions about do you get tested for STIs?
What do you get tested for?
When were you last tested?
What were those test results?
What do you do in terms of barriers or in terms of using condoms, and that kind of thing?
I was able to ask those questions because I was not – the worst thing that could happen is he could say he doesn’t want to talk about it or like I’m weird for talking about it.
And then I just get a cab back to my hotel.
We don’t have to fuck.
There will be other people to fuck in the future.
I think that’s another important thing about talking about STIs without shame is that if you know that this is not your last opportunity for sex and this doesn’t have to happen.
If you can fully trust that there will be other sex in the future, it’s much easier to just talk about it and trust that if it goes wrong, you can just walk away and find somebody else who is a better fit.
Anybody who feels really weird having a conversation with STIs about me or can’t have it or gets upset about me wanting to have it isn’t someone I want to play with because we are just not doing things the same way.
We are not a good fit.
And I think that finding that confidence within yourself makes it a lot easier.
Now, if you get a positive test result and you need to inform somebody about it or talk to them about it if you think somebody may have given you an STI.
I think again, the same way that – earlier this year, I got mono.
I got mono from a person I was dating.
The conversation we had about it was that, “How dare you! How could you give mono? This is the worst thing that ever happened to me.”
It was like, “Hey, I’m sick. Just letting you know. You may want to watch out for symptoms.”
And I was like, “Yup, I am also sick.”
They had at that point gotten tested for Strep.
So I went and said, “Hey, I think it’s probably Strep. The person who I got it from was tested for Strep and put on antibiotics. And a day or two later, they developed a rash which means it was mono.”
So I talked to – my primary care team was like, “Hey, I think it’s mono instead of Strep. Here is why. And just dealt with it, right?"
Same thing for STI, if it had been syphilis instead of mono, the conversation would be like, “Hey, FYI, I had a positive test result come back. I’m getting treated. You should go get tested. I don’t know who – I can’t guarantee who I got it from or whether I gave it to you. It’s best to just get tested. We can check it out. If you have any questions, I’m happy to answer them.”
But if you’ve already done the groundwork I’m talking about, how you handle testing, how you handle safer sex practice, how you handle barrier use, what your approaches to these different decisions.
It’s not a huge deal to talk about it because they already know the kinds of questions folks might always ask like they already know that if you are having sex with other people, they already know whether you use barriers.
They already know who you are not using various with.
It has already been covered.
So it’s a lot easier to have those conversations if you are doing that groundwork before you ever play with somebody.
And again, if you have something like herpes, there may be a lot of folks who freaked out about that and you can decide, do you want to educate this person more about herpes to help them unpack it themselves or do you just want to say like, “OK, sounds like I’m not a good fit for you. Find another person who understands more about herpes, is more OK with taking a risk about playing with someone with herpes and move forward with your life.”
I dated several people who have herpes.
I dated several people who have genital herpes.
I have had long-term relationships with people who have genital herpes.
And I don’t have genital herpes because we use barriers.
They were on valacyclovir.
We did the things that we had to do.
If they felt like they were getting an outbreak, we wouldn’t have sex.
If they had any active sores, we wouldn’t have sex.
We would give ourselves a good window on either side as much as we could.
There are ways to help address issues of transmission.
There are ways to help address any concerns that you have about STIs.
It’s just a matter of like finding that flexibility, doing that creative problem-solving together and remembering that like it’s just an illness.
It’s just another virus or bacteria.
It’s the same as so many other things.
Again chickenpox is a herpes virus.
There are so many different things that we don’t treat with this level of shame and stigma.
So just unpack that within yourself, have conversations about it upfront, do that legwork, and it will come out well for you.